Returning Home

Once your surgery is completed, and you begin to heal, plans will be made for you to return home. There are certain things that you should know before you go home that will ease the healing process. This section will tell you about activity, diet, medication, and other concerns you may have after surgery. It should answer many of your questions, but we would like you to ask about other things that may concern you.

Getting back to a normal routine takes time because your body systems have slowed as result of surgery, medications, and less activity. The healing time will take at least two to three months after you go home. You can expect to have good and bad days during this time and you may feel tired, irritable, anxious, depressed, or simply not quite yourself for a few weeks.

Don't be worried if you express your moods and feelings more than before. A lot of psychological energy is used in coping with the fears and demands after surgery. Talking with your family and friends can help with the normal emotional ups and downs after surgery.

Resuming Physical Activities

A balance between rest and exercise is the key to a successful home recovery. A slow increase in your activity will help promote healing and rebuild your body tone and strength. You should expect to be able to resume many or all of your normal routines within a short time period.

While you are staying at Valley Hospital Medical Center you will be receiving activity instructions from the staff nurses and/or cardiac rehabilitation nurses. Since individual needs vary, we will work with your doctor to develop a plan just for you. This plan will help you increase your activity level while you are home. Listed on this page are guidelines to follow. You should not vary from these guidelines unless your doctor, nurse, or therapist has said to do so in your rehabilitation plan.

• Try to get at least eight hours of sleep each night.
• Get out of bed, get dressed daily, and plan your daily schedule.
• You may shower. Have someone nearby the first few times to help you in case you feel weak or dizzy. You may want to place a stool in the shower stall until you feel stronger. Avoid very hot water. Use mild soap for washing. The incisions may be gently washed, but not rubbed.
• Plan one or two rest periods each day, especially during the first week or two at home.
• When at home, lay down and raise your legs above heart level to help reduce swelling. Do not cross your legs since this reduces blood flow. Avoid standing for long periods of time.
• You can climb stairs when you go home, although you should proceed slowly. Avoid excess trips up and down the stairs. Try to limit yourself to two or three trips per day for about one week after surgery.
• You may engage in light household chores such as cooking, washing dishes, dusting, and desk hobbies. If you are unsure about a certain activity that you would like to continue at home, ask your doctor or nurse.
• A short walk is a great way to speed your recovery. Early on, avoid steep inclines and temperature extremes (below 35 degrees and above 90 degrees), as they put added strain on your heart. Walk during the cooler part of the day in the summer, and the warmer part of the day in the winter. Enclosed shopping malls are a good place for walking when the weather is bad.*
• You may have visitors when you go home but don't tire yourself. You should limit visits to one or two per day for 30-45 minutes until you feel well enough for longer visits.
• You may go for short trips (i.e. to a friend's house, to dinner, to a house of worship, or to a store) so you are not confined to your house.
• You may have questions about having sex after surgery. If you feel good and you are rested, than your sexual activity does not need to be restricted. You may feel that certain positions are more comfortable than others. As a rule, you can resume sex when you are able to climb two flights of stairs or walk three blocks briskly without problems.
• Use the incentive spirometer while you are home during waking hours. Use it once an hour for the first week, once every two hours for the second week, and three times a day for the third week.

Walking daily is encouraged. Distance covered should be slowly increased over time. To be helpful, exercise must be brisk, sustained and performed on a routine basis.

• Brisk: raised your heart rate and breathing rate.
• Sustained: 15-30 minutes or exercise without a break.
• Routine: daily if able to, but at least three times per week. Your cardiologist will discuss the need for a cardiac rehabilitation program with you after you are home.

Until your return visit to your surgeon (three to four weeks after discharge), certain restrictions must be followed:

• Do not drive a car. Your reaction time will be slowed, and you must avoid danger of re-injuring the breastbone while it is healing. You will be able to resume driving when cleared by your surgeon. You may ride in a car with your seatbelt on.
• Do not lift, carry, push or pull items weighing more than five to ten pounds, such as a heavy shopping bag, suitcase, or small child. You should avoid tenuous exercise, such as swimming, jogging, biking, bowling, tennis, and golf for three months after surgery. No arm exercises, rowing machines, or arm cycling is allowed during this time.
• Do not do heavy house and yard work such as running a vacuum, mopping or scrubbing floors, mowing the lawn, raking, digging, or chopping wood. These chores will strain your chest and upper arms and will affect proper healing of the breastbone.
• Do not return to work. After your follow-up visit, your doctor will discuss your return to work. Many factors will be discussed-the type of work you do, your physical state, and the results of your followup examinations. If your job does not involve heavy lifting, you may be able to return to work in about three months, as long as you are healing well.

Caring for Your Incisions

As you heal, your incision will look better and the soreness will go away. Changes in the weather, too much or too little activity, and sleeping in one position too long can cause this soreness. You may also feel numbness or itching, or see redness or swelling, which will also stop with time. To care for your incisions, we suggest:

• Wash gently with mild soap during your daily shower. Dry carefully with a towel. Pat it dry, but do not rub the incision.
• If you have steri strips (small pieces of white tape) over your incision, you must remove them after you have been home for seven days. If the strips come off on their own, you may leave them off.
• If your incisions are puffy, have areas of redness, are oozing, or begin to open slightly, call your surgeon.
• Women should wear a bra. A good support bra will reduce the tension placed on the incision. If the bra bothers you, you may put a small piece of gauze under the bra for added comfort.
• For discomfort or soreness, you may use a heating pad. Apply it four or five times per day on the low setting for about 20 minutes each time. If needed, take Tylenol or another pain medication prescribed by your doctor.

Common Symptoms

After heart surgery, many people have symptoms that will improve with time, such as:

• Clicking or rubbing of the breastbone with movement or breathing. Once you have completely healed (about three months) this often stops.
• Swelling or knot-like lump at the top of your chest incision. This often goes away in six to eight weeks.
• Aches between your shoulder blades, over the ribs, in the back of the neck, chest or leg incision. This may last for many weeks and lessen with time.
• Tingling or numbness in your elbow or fingers. This may be due to the way your arm was placed during surgery.
• Slight swelling in your legs, which lasts four months or more. Keeping your legs up above heart level when sitting and sleeping will help this problem.
• Weakness and hoarseness in your voice may be present because of the breathing tube that was in place during and after surgery. This improves in a couple of weeks, although it may last longer.
• Constipation is a common problem and can be controlled with a mild laxative or diet changes. Increasing your daily routine, eating more fresh fruits, vegetables, and other high fiber foods often helps.
• You may have a difficult time sleeping while you are in the hospital and also at home. Some common reasons are lack of exercise, a decrease in your daily routines, anxiety about surgery or being at home, family matters, depression, and incisional pain or discomfort. Try to decide what may be causing your sleeping problem and talk to your doctor about ways to resolve this.
• Numbness and soreness on the side of your chest where the internal mammary artery is located.

Diet

You may not have much of an appetite after your surgery, but it will increase as you recover. A balanced diet helps your body heal and lessens fatigue. Each day, eat a wide range of fruits, vegetables, whole grains, breads, meats, and dairy products. Eat less foods with a high content of fat, cholesterol, sugar,and salt. If a special diet has been ordered, your nurse and dietician will be able to help you learn these changes.

Everyone should be on a heart-healthy diet. Your nurse or dietician will help you learn. We also suggest you follow these guidelines from the American Heart Association:

• Planning menus ahead of time will make it easy to prepare balanced meals.
• Egg yolks, even eggs you add in cooking, should not exceed three per week.
• Select low fat or skim milk instead of whole milk. Cheeses made from skim milk are preferred since they are low in fat and high in protein.
• Eat ice milk, frozen yogurt, tofutti, or sherbet in place of ice cream.
• Oils and margarine should have no more than two grams of saturated fat per tablespoon, such as canola, olive, corn, safflower, sesame or sunflower oil. Avoid coconut oil, palm oil, or cocoa butter- they are high in saturated fats.
• Use fish, white meat chicken, and white meat turkey for most of your meat dishes. Use small portions of beef, lamb, veal, and pork.
• When choosing meats, pick lean cuts. Trim any fat you can see before cooking and avoid deep fat frying. Use cooking methods that help remove fat such as baking, broiling and roasting. Use a rack while cooking so fat will drip off the meat.
• Limit liver and organ meats to one serving per month.
• Restrict use of processed meats such as cold cuts, hot dogs, salami, sausage, bacon, and liverwurst.
• Reduce salt. Avoid foods with high salt content and do not add salt while cooking. To make foods more tasty, use basil, chives, lemon, parsley, garlic powder, and marjoram. Check with your doctor before using a salt substitute.
• Avoid weight gain above your normal weight, as this places added strain on your heart. Eating fewer foods high in sugar and in fat, eating smaller portions, and increasing activity will help you control your weight.

Smoking

Smoking is harmful to your lungs, heart and new grafts. Smoking raises your heart rate and blood pressure, narrows blood vessels, and causes spasms of the heart vessels. Research has shown that new grafts clot much more often in smokers than in non-smokers. If you smoke it is now more important than ever that you stop. Ask family members who smoke to quit with you.

If you need more guidance, your cardiac rehab nurse can provide you with information on community groups that can help you quit smoking.

Drinking

Coffee, tea, and sodas have a high caffeine content which is harmful to your heart. Reduce your intake of these liquids to one or two servings a day or switch to the decaffeinated versions. If you sometimes enjoy an alcoholic drink, you may do so after surgery. But, during your recovery your alcohol intake should not exceed two or three onces per day. You should not drink alcohol if you are taking pain pills, sleeping pills, or tranquilizers. To be sure, ask your doctor or nurse if alcohol will react with any of your pills.

Medications

Most patients need medications while they are healing. Before you are discharged from the hospital, your doctor will prescribe the medications you will take home. Do not take any of the medications you were using before surgery unless you are told to do so by your doctor. Do not increase, decrease, or stop the amount of your medications without your doctor's advice. Once your prescriptions are written, one of your nurses will discuss each medication with you and give you a schedule. Keep your schedule on the refrigerator or another visible place, and bring it with you when you visit your doctor.

Reasons to Call Your Doctor

If you feel any of these symptoms, report them to your doctor or nurse:

• Palpitations or a heart rate greater than 120 beats per minute when you are at rest, or a change from a regular to an irregular pulse.
• Increased fatigue or shortness of breath at rest.
• Temperature above 101 degrees more than one time, or chills for 24 hours.
• Excessive redness, swelling, soreness, or drainage from any wound site.
• Swelling in your ankles and hands with a weight gain of two or more pounds in one day or five pounds in one week.
• Abnormal pain or other symptoms that do not go away with your medication.
• Pain in the calf of your leg.

Follow-Up

Your physician will want to see you for a follow-up visit in about three to four weeks after discharge. If your appointment is not made for you before you go home, be sure to call the doctor to schedule one once you are home.

A report of your operation and your progress will be sent to your family doctor. You should also schedule a visit with your cardiologist and family doctor after you are home.